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目的探讨氨基末端B型钠尿肽原(NT-proBNP)浓度变化对急性心肌梗死(AMI)患者预后及死亡风险评估的意义。方法采用双向侧流免疫法检测54例AMI患者、30名健康对照者以及AMI患者治疗后第3d、第7d血清NT-proBNP水平。所有患者平均随访180 d,观察随访期间发生的主要不良心脏事件(MACE)。结果 AMI组患者进院时血清NT-proBNP水平较对照组明显升高(P<0.01),且与AMI后患者心功能分级(NYHAⅠ~Ⅳ)呈正相关(r=0.71,P<0.01)。随心功能分级递增,血清NT-proBNP水平逐渐升高,随访期内发生的MACE明显增多。NYHAⅢ~Ⅳ级组MACE发生率明显高于NYHAⅠ~Ⅱ级组(P<0.01)。治疗前,≤3d死亡组血清NT-proBNP水平明显高于其他组(P<0.01),治疗后第3d,4~30d死亡组血清NT-proBNP水平比治疗前明显升高(P<0.05),亦高于非死亡组(P<0.05)和31~180 d死亡组(P>0.05)。治疗后第7d非死亡组血清NT-proBNP水平比治疗前明显降低,亦明显低于2个死亡组(P<0.01)。结论血清NT-proBNP水平与AMI患者心功能损害程度及预后和死亡风险密切相关,观察AMI患者早期血清NT-proBNP水平及其在治疗过程中的动态变化对AMI患者预后和死亡风险评估有重要价值。
Objective To investigate the significance of the change of concentration of NT-proBNP on the prognosis and risk of death in patients with acute myocardial infarction (AMI). Methods The levels of serum NT-proBNP in 54 AMI patients, 30 healthy controls and AMI patients on the 3rd and 7th day after treatment were measured by bidirectional lateral flow immunoassay. All patients were followed up for an average of 180 days to observe the major adverse cardiac events (MACE) that occurred during follow-up. Results The serum level of NT-proBNP at admission was significantly higher in patients with AMI than in controls (P <0.01), and positively correlated with NYHA Ⅰ ~ Ⅳ after AMI (r = 0.71, P <0.01). The function of heart function increased gradually, the level of serum NT-proBNP gradually increased, and the MACE occurred during the follow-up period obviously increased. The incidence of MACE in NYHA Ⅲ ~ Ⅳ group was significantly higher than that in NYHA Ⅰ ~ Ⅱ group (P <0.01). Before treatment, serum NT-proBNP level was significantly higher in the death group than 3 days (P <0.01). Serum NT-proBNP level in the death group 4 and 30 days after treatment was significantly higher than that before treatment (P <0.05) Also higher than non-death group (P <0.05) and 31 ~ 180 d death group (P> 0.05). Serum levels of NT-proBNP in non-death 7 d after treatment were significantly lower than those before treatment and also significantly lower than those in 2 death groups (P <0.01). Conclusion The level of serum NT-proBNP is closely related to the extent of cardiac dysfunction and the risk of prognosis and mortality in patients with AMI. To observe the early serum NT-proBNP levels in AMI patients and its dynamic changes during treatment is of great value in assessing the prognosis and mortality risk of AMI patients .